Bad Breath - A Social Taboo

Halitosis, also simply known as bad breath or malodor or Fetor ex Oris, is a fate sometime worse than even herpes. Bad breath may not kill you physically, but it sure is one of the most common embarrassing ailments anyone can have. It tops acne and even loss of hair as one of the most embarrassing conditions one can have. The disorder occurs in all people, does not discriminate between race culture, age or sex. It is a very demoralizing disorder one can get. To make matters worse, it creates difficulty in social and personal life. Bad breath impacts the lives of millions of individuals in North America alone. The individuals afflicted with this common ailment are so embarrassed that they are even reluctant to mention their problem to either their physician or dentist. Another unfortunate fact is that most halitosis sufferers have no idea that they have a breath problem unless somebody directly informs them. People suffering from halitosis have been known to become withdrawn and avoid social situations. A few unfortunate individuals have even committed suicide. One can dress well, have a decent hair cut. Look primp, proper, sexy and have a million dollar look but bad breath can dissipate that feeling in a second. The disorder can strike anytime and ruin your perfect day. It may occur first thing in the morning or just after lunch or at a business meeting. And whenever it happens, you never have any mints, sprays or mouth wash with you. The only salvation is frequent smelling of your breath with your hands over your mouth-that does not cure the condition but sure as hell makes you go paranoid. Bad breath for some unknown reason is a big social Taboo and all individuals are so embarrassed that they just do not tell anyone- and so the agony is prolonged. The majority of the individuals with bad breath self treat their condition for years before seeking any medical advice. The mouth wash industry has burgeoned into a billion dollar industry. They are thousands of products available, hundreds or mother water rinses, every type of gum, exotic dental flosses and even mouth sprays. This is all fine but they are temporary measures and do not cure the problem. In most individuals, the cause of bad breath is in the mouth. Bad breath occurs because bacteria in the mouth start to grow on decaying food or debris. There are millions of bacteria in the mouth and they normally function to keep the mouth clean and get rid of other predators. However, when the oral hygiene is poor and the dental care is non-existent, the bacteria start to grow on the debris and also encourage other bacteria to grow. The bacteria then generate gases like hydrogen sulfide (there are other gases also) which are the main cause of bad breath. The condition then starts to worsen like a stagnant toilet which is not flushed. If the oral care is poor the bad breath just progresses and gets worse. Everyone has bad breath during waking up in the morning- and this is normal; even Romeo and Juliet had to suffer the morning woes of a smelly mouth. The reason for this is that the mouth has decreased saliva during the night and the salivary glands also function less during this time period. This environment allows the residential bacteria to grow and generate a noxious smell. This bad breath is worse in individual who are mouth breather- since this dries up the mouth more. However, this is a transient condition and easily treatable. Rinsing and dental care will remove the bad breath and a fresh aroma will appear. Another common reversible and transient scenario is that of bad breath after prolonged fasting. This bad breath may have its origin in the stomach. When one has not eaten food for a prolonged time, the acids and various other juices in the stomach mix with the bacteria and generate gases which are emitted by the mouth. Again, the condition is easily treatable. Eat and drink on time. In most cases, the individual has no idea he/she has bad breath. The majority of us fall into that category. Each and every adult has had bad breath sometime or another and it occurs when least expected. Sometimes the intensity of the smell is mild and in some cases- simply awful. The individual will either be told he has the problem or finds out that he is being shunned or avoided. And when someone is told that he has a bad breath problem, the stigma is life long and will drive most people to paranoia-forever smelling trying to smell the mouth by blowing on his hands. In today’s world of aesthetics we are all paranoid about bad breath and anyone even looking at us in a peculiar way and we feel like we have something wrong with us. Similarly, many individual who do not have bad breath but begin to develop wild imaginations- smelling things in their mouth which do not exist. These individuals become so paranoid that they develop anti social behaviors and become depressed.

The majority of individuals with bad breath have an oral condition as a cause. If a person has healthy teeth and gums (i.e. no cavities, gum disease or abscesses), the next most common source of oral malodor is the tongue. And it is hard to believe but more than 70% of the population never cleans their tongue. These individuals wipe their back side after pooping, but yet never bother to clean the tongue. The tongue has a lot of furrows and has a tendency to grow bacteria in the grooves. With time, food particles also get into the grooves and the combination of bacteria and food is bad news. Bacteria have the ability to generate a variety of sulfur chemicals (hydrogen sulfide) that are released in the mouth. The majority of the bacteria collect in the posterior aspect of the tongue which is difficult to access for cleaning. Other factors in the oral cavity that can make halitosis worse is the presence of any infection of the gums, teeth, lips or a very dry mouth. Some foods that are associated with bad breath or pungent smell are garlic, ginger, onions, horse radish, eggs, broccoli, fish, meat, peppers, cigarettes, alcohol and yes, even, coffee. However, for those who do not eat these foods does not mean they are immune from bad breath- bad breath can occur anytime when bacteria starts to putrefy on debris and residual food in the mouth. Medical conditions are a rare cause of bad breath and most of these individuals have a long history of being sick. Recurrent infections of the tonsils, throat and the lungs are a common cause of bad breath.

 

However, these individuals are generally ill looking and have other features of the disease, besides bad breath. Liver and kidney disease are always associated with bad breath and this is commonly seen in hospitalized patients. The odor is distinct and resembles rotten eggs. Diabetics can also produce an acrid smell when they are sick. However, in all the above cases, the cause is obvious. Foreign bodies are another common cause of bad breath. In children and some young adults, the foreign body may be in the nose or sinuses and plug up the secretions. The secretions in the nose and sinuses offer a great environment for bacteria to grow and hence bad breath evolves. Most foreign bodies can be detected by either a physical exam or a radiological test. Sinus infections are another common source of bad breath. These individuals always have a constant nasal drip and a congested nose. They have thick secretions which provide an environment for bacteria to grow. Stress can also be a transient cause of bad breath. Just like a burst of sweat under the armpits, stress does unusual things in the mouth and generates bad breath. Fortunately, stress related bad breath is only transient and disappears when the stress subsides. Menstrual periods have long been associated with numerous physiological changes in the body and bad breath is just one more finding. Usually this phenomenon is common just at the time of menstruation. The female is usually unaware of the bad breath but the partner is almost always aware (unless he has anosomia). Conditions which can worsen bad breath include: - excessive mouth dryness - sinus allergies - post nasal drips - sinus congestion

Most individuals who have halitosis do not need a lot of work up- especially the younger adults. In most cases, the individuals seek medical help after a long time because of embarrassment. There are no specific tests to make a diagnosis and the patient has to be examined. There are no objective tests to make a diagnosis of halitosis. In most cases, the individual describes the situation or has been told by his family or friend that he has bad breath. Unless the individual is not moribund or dying, then the investigations are limited and not useful. To evaluate the cause of bad breath the physician may take samples from your mouth, tongue and even nose. All these tests are non specific and vague. In addition, any drips from the nose will also be analyzed and cultured. There are many devices available to detect and monitor bad breath but these are a waste of money and neither specific nor sensitive. The best test to monitor bad breath is asking a family/friend to smell the mouth. Despite the fact that we have all types of Scans and expensive machines, this simple test is still the gold standard. Another method of detection is to scrape the tongue with a spoon and smell the odor. Medicine never ceases to be fun. Today there are home kits to assess for bad breath. One takes a cotton tip applicator and swipes the tongue and places it back into the sterile tubes. If the tube changes color (meaning bacterial growth), it indicates bad breath may be occurring. The tube may not immediately change color and in some cases may take a few days. Not a very sensitive test because many normal bacteria in the mouth will also cause a color change. There are also portable machine which analyze hydrogen sulfide in the breath. However, most of these machines lack any sensitivity and can provide misleading results

Before undertaking expensive physician consults, the first attempt should be clean, floss and scrape the tongue. In the majority this may decrease or eliminate the problem in a matter of days, only if this is not successful should further investigation be done When the above fails, more aggressive treatment is required. A visit to the dentist should be the next step and a thorough evaluation of the teeth is a must. If no dental caries are evident, then frequent flossing and brushing of the teeth is recommended. Regular scrapping of the tongue and the hard palate is essential to resolve the condition. Other additional methods may include frequent rinsing with mouth washes, antibiotics to control a sinus infection, avoid spicy foods and drink lots of water.

There are hundreds of mouthwashes available and in general they all do well to temporarily decrease the bad breath. New oil based mouth washes are also available and they perform much better than the water based mouth washes. Some home based remedies include adding a little olive oil to the regular mouth wash and using it as an oil based mouth wash. Most studies indicate that for moderate to severe halitosis, this oil based washes perform a lot better than regular mouth washes. Overall, Listerine has been found to be effective for rinsing the oral cavity. Listerine also contains essential oils (thymol, methanol, eukalyptol) and methyl salicylate. It is best not to use the antibiotic containing mouth washes on a regular basis because it may also kill the normal bacteria in the mouth and give rise to the growth of fungal infections. The best mouth washes include those containing ammonium zinc, chlorine dioxide or trichlorosan. Chlorhexidine has strong anti microbial properties and thus its use should be limited. Using mouth washes without flossing or scrapping the tongue is of little use. Halitosis needs a combination of oral hygiene care and no one treatment is useful. Regular dental care is important to detect any occult gum disease.

- have regular dental care - brush after every meal - floss regularly - use non alcohol based toothpaste - brush the tongue or scrape it regularly - avoid alcohol - avoid spicy foods - do not smoke - drink lots of water All the fancy water piks and tooth brushes on the market are not only expensive but are no better than a regular tooth brush. However, if you have money to burn then there is no harm in using these mechanical appliances.